Conversations with the College

COVID-19 & Occupational TherapyLesley Krempulec, OT Reg. (Ont.)Practice Consultant

April 16, 2020

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Outline

Questions & Answer

▪Essential service▪Virtual practice ▪Redeployment

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College Position

Directives from the Ministry of Health and the Premier’s office are reflected in College positions.

The College is working with government to respond to this pandemic in the best interest of the public.

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Question 1: Essential Service

Answer: A general guideline when determining essential occupational therapy service:

Would the client’s health or function considerably decline if occupational therapy service is not provided?OR Is delivery of the service time-sensitive to avoid a negative outcome?If the answer is yes to either question, the service is considered essential.

Question: During this pandemic we, as health care providers, have been told to stop or reduce of all nonessential service. Urgent care and essential services continue. So, what does this mean for occupational therapists?

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Question 1: Continued

1. Write down a rationale or guiding criteria on what is essential in the OT’s area of practice2. Refer to the guiding principles set out by Ministry of Health and considerations that COTO developed3. Call COTO practice resource service at 1-800-890-6570 extension 240. Practice consultants can help talk you through some of these situations.

Office of the Chief Medical Officer of Health (Directive # 2- for Health Care Providers)

Premier’s Office: List of Essential Workplaces

College Guidance for Occupational Therapy Services During COVID-19 (April 6)

Occupational Therapy Services During COVID-19: Providing Clarification (April 8)

Steps to Take:

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Question 2: Virtual Practice

We have invested in online platforms so we can provide virtual care to clients. I am confused – can or can we not do online occupational therapy? Yes. Occupational therapists can provide essential services either by telephone or other virtual means. In-person services can only be provided if the service is urgent.

COTO Information on COVID-19 – FAQ

Guidelines for Telepractice in Occupational Therapy

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Question 3: Virtual Practice

Much of what occupational therapists do can be considered essential. If the service either prevents considerable decline OR avoids negative outcomes in clients or their families, it can be deemed essential and therefore can continue.

I work in private practice and am delivering service virtually. Does that mean I have to stop my practice if not considered essential? If services were not needed, I would discharge the client and they might regress.

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Question 3: Continued

For those clients who have nonessential needs for this temporary period we suggest an OT follow “on hold” or “prolonged absence” procedures for example:

▪ communicate to clients, referral sources and others about the reason for the delay or deferral in service▪ keep clients informed as ongoing direction becomes available regarding ability to provide service

A client’s status can fluctuate during this period so have a clear plan on how to monitor status or instructions for clients should their status become urgent/essential.

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Question 4: Virtual Practice

Can the College recommend, sanction, or approve platforms to be used for telepractice?No. With new technologies emerging, the College does not recommend or endorse specific online platforms for virtual care. Occupational therapists should take reasonable steps to investigate the security and privacy of platforms.Professional associations may have resources on platforms.

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Question 5: Virtual Practice

Yes. If the OT has determined that providing service virtually is a clinically effective and an appropriate way to deliver the service and a client understands factors like:▪potential privacy risks in transmission and storage of data▪impact digital means may have on the quality of the assessment or interpretation of the clinical data▪client's ability to clarify and add additional clinical data

*The requirement for OTs to obtain client consent is the same for telepractice and in-person client interactions.

Guidelines for Telepractice in Occupational Therapy Standards for Consent

Can patients and clients send pictures or videos of themselves from their own devices to us to help in the assessment process?

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Can the College provide an outline of fees for online services?

No. It is beyond the authority of the College to establish fees for occupational therapy services.

Fees must be fair and equitable, and billing practices must be transparent.Guidelines for Private Practice

Question 6: Virtual Practice

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Question 7: Virtual Practice

I am a therapist registered in Ontario, but I have clients that because of COVID-19 have returned home to another province. Can I still provide virtual services to them?Yes. However, the jurisdiction for the provision of occupational therapy services is defined by the location where the client resides - even if they reside there temporarily.

February 2018: Telepractice with Clients Outside Ontario

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Question 7: Continued

An OT wanting to provide out-of-province service will:

1) Determine if the service is essential and if it can be effectively provided virtually or by phone.2) If yes, contact the regulatory College in the province of the client to request temporary registration. Most provinces are waiving fees and expediting the process. 3) Upon receipt of temporary registration, provide the service virtually.

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Question 8: Redeployment

▪focus on the transferable skills that can be leveraged ▪OTs should have appropriate training and competency (knowledge, skills and ability) to safely perform activities ▪seek out shadowing and training opportunities and plans to address difficult or unfamiliar situations.

Standards for Occupational Therapy Assessments

What does the College say about OT redeployment to areas where OTs do not feel they have competency? What are the expectations for OTs who find themselves in these situations?

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Question 9: Redeployment

We may not have the time or, in some cases, access to document as usual. What is expected for documentation during the pandemic? ▪Standards for Record Keeping still apply▪Possible to streamline or change current documenting processes

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Question 9: Cont’d

Balance what is needed and what is reasonable given that we are in a pandemic.

Standards for Record KeepingGuidelines for Working Within Managed Resources

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Evolving Guidance

Watch for:

• New and revised Ministry guidance regarding long-term care and congregate settings

• New Ministry guidance regarding mental health and addictions

Continue to check your email and visit our COVID-19 webpage.

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How to Reach the Practice Resource Service

Practice Resource ServiceEmail: practice@coto.org

Call: 416.214.1177/1.800.890.6570 x240

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